Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Apr 2007
ReviewDuodenal levodopa infusion for the treatment of Parkinson's disease.
Motor fluctuations are a common problem in the long-term management of Parkinson's disease (PD), resulting in disability and impaired quality of life. The relatively short serum half-life (approximately 90 min) of oral levodopa/carbidopa and its erratic absorption due to delayed and inconsistent gastric emptying (a non-motor feature of PD) are thought to be important factors in the development of motor fluctuations. Continuous infusion of levodopa/carbidopa directly into the small intestine of PD patients results in marked reduction of motor fluctuations by reducing plasma levodopa variability by an order of magnitude over oral therapy. ⋯ The development of a micronized levodopa (20 mg/ml) and carbidopa (5 mg/ml) suspension utilizing a methylcellulose gel provides the high levodopa concentration and physical and chemical stability necessary for long-term enteral therapy. Clinical evidence indicates that a marked reduction of motor fluctuations and dyskinesias can be achieved and maintained by intraduodenal administration of this suspension. This article reviews the published data describing the efficacy and safety of duodenal levodopa, and discusses its current and potential role in meeting the needs of PD patients.
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Expert Opin Pharmacother · Apr 2007
ReviewSevere community-acquired pneumonia: approach to therapy.
Despite substantial progress in therapeutic options, severe community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality worldwide. Recognising the clinical importance of CAP over the past several years, different medical societies and health organisations in different countries have proposed specific guidelines for the management of CAP. Early and rapid initiation of antimicrobial therapy has been advocated for a favourable outcome. ⋯ Dual therapy is emerging as the preferred therapy for severe CAP. The regimen is based on an epidemiological approach with emphasis on covering both typical and atypical pathogens. Non-antimicrobial adjuvant therapies including non-invasive ventilation and immunomodulatory agents are emerging as promising area for future development.
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Expert Opin Pharmacother · Apr 2007
Meeting highlights of the European Respiratory Society annual congress 02-06 September 2006, Munich, Germany.
In pulmonary medicine, there are two major international meetings held annually: the annual meeting of the American Thoracic Society (ATS), and that of the European Respiratory Society (ERS). The 2006 ERS Annual Congress was held in Munich, Germany. ⋯ With > 5000 abstracts and ~ 17,000 participants, the 2006 ERS-congress outnumbered even the 2006 ATS meeting. Research areas covered all aspects of pulmonary diseases, although this year (as in previous years) obstructive pulmonary diseases such as COPD (chronic obstructive pulmonary disease) and asthma were clearly the main focus.
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Expert Opin Pharmacother · Mar 2007
ReviewPostoperative pain management: new, convenient analgesic therapies.
Despite the potential benefits to patient health that can result from effective pain management, survey results continue to indicate that acute postoperative pain remains inadequately managed worldwide. The development of novel analgesics and advanced analgesic delivery techniques has the potential to improve current strategies for postoperative pain management. This article outlines the pharmacological principles and clinical utility of recently developed agents and a novel drug delivery device indicated for the management of moderate-to-severe acute postoperative pain.
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Expert Opin Pharmacother · Feb 2007
ReviewErtapenem: the new carbapenem 5 years after first FDA licensing for clinical practice.
Ertapenem, a parenteral broad-spectrum 1-beta-methyl-carbapenem, was licensed 5 years ago for clinical practice in the US and Europe. The substance has a good in vitro activity against many common aerobic and anaerobic Gram-positive and -negative bacteria. Its in vitro activity against Enterobacteriaceae carrying plasmid- or chromosomal-mediated beta-lactamases, including AmpC- and extended-spectrum beta-lactamases, is especially clinically significant. ⋯ International guidelines recommend the initial empirical use of ertapenem for intra-abdominal infections, skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections and pneumonia (both community-acquired and 'early-onset' nosocomial) in a dose of 1.0 g administered once daily. However, recent results from pharmacokinetic/pharmacodynamic modelling studies in critically ill patients with ventilator-associated pneumonia and adipose volunteers with a body mass index of > or = 20 kg/m(2) showed that the standard dose of 1.0 g/day may not provide adequate free, protein-unbound drug concentrations in plasma and organ tissues. Therefore, a shortening of the dosage interval or continuous infusion of ertapenem should be considered to ensure optimal free concentrations in these particular populations.